06/12/08

Modification to Applicability Date for Reporting Retained Rebates

CMS has modified its guidance on reporting RDS rebates and similar price concessions, which may affect certain RDS applications with plan years beginning any time between July 1, 2006 and December 31, 2006 (inclusive of those two dates).

Under the modified guidance, the requirement to report rebates and similar price concessions retained by a Pharmacy Benefit Manager (PBM) applies only to RDS applications with plan years beginning on or after January 1, 2007 (i.e., it does not apply to RDS applications with plan years beginning on any date between July 1, 2006 and December 31, 2006, inclusive of those two dates). It is permissible to report such retained rebates for applications with plan years to which the requirement does not apply.

Please be aware that all other requirements relating to the reporting of rebates and other price concessions do apply to ALL RDS applications, regardless of the application's plan year start date.

The modified guidance also includes new examples illustrating how the requirement to report retained rebates applies, with respect to RDS applications with plan years beginning on or after January 1, 2007.

In addition to modifying the guidance on this topic, CMS has accordingly modified a previously published reminder about this topic. For more information, go to: Important Reminder About CMS Guidance on Calculating and Reporting Rebates - UPDATED.

If you have questions or need additional information about the modifications to the guidance, please call (410) 786-0709, and leave a voice mail with your name, the name of your organization, and your telephone number.